Wednesday, February 23, 2011

On Communication, Science, and Vaccines

Andrew Revkin has a fascinating post on scientific communication where he admits to being a "recovering denialist."

No, not of climate change. Instead, Revkin was in denial about the influence of scientific communication. He writes:

"My denial, I said, lay in my longstanding presumption, like that of many scientists and journalists, that better communication of information will tend to change people’s perceptions, priorities and behavior. This attitude, in my view, crested for climate scientists in the wake of the 2007 report from the Intergovernmental Panel on Climate Change."

This kind of denialism is pretty popular among many scientists (including us social scientists). We assume that people do not agree with us because they are misinformed. But if only someone took the time to teach them, they would, of course, immediately concede our point.

This all reminded me of an excellent blog post I had read recently on Occam's Typewriter about treating people who refuse to vaccinate their children with respect.

This is an issue that never fails to generate controversy, in part because, frankly, all parenting decisions are controversial, and in part because individual decisions not to vaccinate affect the collective group.

I myself will admit to being virulently pro-vaccination. And as much as I try hard to eschew judginess, I will admit that when I hear that a parent hasn't vaccinated, my inner Judgey McJudgeypants gets very huffy. "Oh, good to know," I think. "I'll make sure that my hypothetical babies are never anywhere close to your unvaccinated children."

The truth is, I do think (and here I may get flamed) that the collective benefit to immunization overrides any individual right to choice in this arena. I would mandate immunizations by fiat if I felt that such a law would be effective.

But that's not the current law, and I honestly suspect mandatory vaccines might trigger a greater backlash. So instead, people in the vaccine movement (did you know it was a movement?) write books like Paul Offit's, Deadly Choices: How the Anti-Vaccine Movement Threatens Us All and speak in really aggressive terms about those who don't vaccinate.

Those who are pro-vaccine often denigrate the anti-vacciners as stupid or anti-science. As Richard points out in his post, that charge is pretty unfair. He notes that when his first child was born, he refused the MMR. Later, when he learnt that the connection between autism and vaccines was specious, he changed his mind.

But not all anti-vaccinaters are simply confused or uneducated. A number have done vast amounts of research on vaccination and have concluded, for whatever reason, not to vaccinate.

The reality is better communication will change some people's minds, but it won't change everyone's. As an eco-blogger, I know too well that scientific evidence of lack thereof isn't the ultimate arbiter of what people will do. There may not be concrete scientific proof for a number of things- Alzheimers caused by commercial anti-perspirant for example, but that doesn't necessarily convince people. Is there a definitive causation between say BPA and cancer? No. Are there studies that suggest BPA might cause cancer? Yes. Are there studies that suggest that BPA is harmless? Yes. Are there a number of people who will avoid BPA because we just don't know? Yes.

And therein lies the rub. As a social scientist, I have learned how uncertain a lot of science really is. I know now just how tough it is to determine causation. Simply put, there's just a lot out there we really don't know. As a result, the public often hears, "Science finds eggs are bad for you," followed a few years later by, "Science finds eggs contain key essential nutrients." Given how often the "science" we hear seems to get twisted and turned, is it any wonder that people don't necessarily always trust in science?

Now, you might argue, the vaccine thing is different. The link between vaccines and autism has been completely and totally debunked. The key study was fabricated! There's no scientific uncertainty here (except for a few cranks and weirdos)!

To which I would say, one, not everyone in the world thinks that the cranks and weirdos are cranks and weirdos, but two, and more importantly, there is still some major uncertainty here. We still by and large know very little about why and how autism develops. Until we get some major and much more certain answers, people will be wary about any possible connection no matter how spurious scientists claim them to be. Sure, scientists say that there's no connection between autism and vaccines. But they don't seem to be offering any other very plausible explanation, so why believe them?! (I will add that for many parents, a link between autism and vaccines may be comforting. Vaccines are so easily avoided compared to things like phthalates which are much more ubiquitous.)

Secondly, I think it's fair to point out that vaccines haven't always been safe. And the government hasn't always ensured that vaccines were safe. Again, as an eco-blogger, I understand not trusting the government, because well, I don't entirely. I may understand that the government has approved a panoply of items including non-stick pans and paraben filled shampoo, but I don't necessarily believe that the government always has my best interests at heart.

This all brings me back to a This American Life I listened to ages ago where a reporter actually listened to those in the anti-vaccine movement and concluded that those parents who were anti-vaccines simply didn't trust the government or the mainstream medical community.

That's a scary place to be. But, frankly, it's also understandable.

Science claims to be different from religion because it's evidence based. But in a world filled with contradictory evidence, what is a person to believe? Science is contemptuous of faith and yet implicitly relies on a public "faith" of science. Faith in science, faith in scientists, faith in the scientific process. And while faith in science might seem more rational than faith in God, science can be and has been wrong, science can be and has been skewed, and science can be and has been uncertain.

Science is like the Godfather whispering to the public to trust no one. And then, when the public, having imbibed this wisdom, turns on science and starts questioning it, science is shocked. But it shouldn't be. We're just following its advice.

23 comments:

This is a really difficult issue for me. I am rabidly pro-vaccine for the same reason you state -- I believe herd immunity to scary, deadly diseases outweighs any concern I might have about the safety of vaccines. But my community of friends -- particularly those in the natural birth/doula/homebirth community -- are rabidly anti-vaccine. My response thus far has simply been avoidance. I do not speak up when they rail against vaccines because I know they have done their research and nothing I say will convince them otherwise. It seems like a waste of energy to argue with them. But I know that when I have my own children -- children I fully plan to vaccinate -- this is going to be a serious issue among my friends. And I'm honestly not sure at all how to deal with it when that time comes.

I read recently on the CDC website that over 30% of deaths in 1900 were in children under 5. What's that number now? 1.4%. Children dying now is pretty rare - people under 50 just don't remember those times when it was fairly common for our children to die. Sometimes mistrust of the government and scientific community is justified. But maybe we could talk to our great-grandparents - those people who might still remember when 10% of babies died before they were one, and kids regularly died or were crippled by polio, smallpox, and measles. Not all of that child-death reduction came from vaccinations, but a significant portion did.

Half Hearted, that is a tough tough position you are in. I don't envy you. Are you sure you want to tell your friends since it probably won't change their minds?

Peak Oil, well of course I agree with you, but what would Half Hearted Hippie's friends say? As she points out, they have done their research. They just choose to look at it differently.

Rosa, you know, that is an EXCELLENT point and one that I had not thought of. You know, I am not a fan of the judging, but maybe I will totally judge those that don't vaccinate. And by judge, I mean, not think they're stupid, not think they're uninformed, but just think they are morally wrong. Wow that's kind of scary. Can I SAY that on the internets? That I think something is morally wrong? Well, I guess I just did.

Anon, I think you missed my point. What I meant is that not trusting the government or the mainstream scientific community can be scary because then ... who do you trust? Unless you yourself want to devise and run experiments about vaccines and autism, you have to sort of trust someone. Either you trust the peer reviewed journals you read, or you trust the scientists, etc, etc. Yes it is good for individuals to inform themselves and make their own decisions, but at the end of the day informing yourself comes from some amount of trust.

I'll give you an example. I'm a well-informed individual who doesn't always trust the government or the mainstream medical community. I learned that there's considerable dispute about whether coconut milk is bad for cholesterol. On the one hand, it has a lot of saturated fat. On the other hand, it's a different kind of saturated fat than animal saturated fat. While I suspect that actually coconut milk would be okay, at this point, I'm sticking to the American Heart Association guidelines and forgoing the coconut milk. Do I entirely trust the American Heart Association? No. Do I seek out outside evidence? Yes. Do I sometimes rely on the AHA even if I don't trust them entirely? Yes. That is not a scary place to be. Because there is some level of trust. No trust at all? Scary.

But it's a hard point to balance - this has been an ongoing discussion in activist circles for years. We don't want groupthink, but we do want change. We can go for laws, social pressure, or education. Education seems to fail. Laws are hard to enact. But we're really uncomfortable with social pressure (at least officially) so...are we actually doing anything to cause change?

Personally I exert downward pressure on my neighborhood's lawn & garden beauty standards just by existing, and a little bit of social pressure by forcing my friends to walk & recycle when they're here (not that they need much forcing) but I've been sticking with telling the truth when asked on the vaccination thing.

You know, you've made me think on this one. I'm pretty much in the same pro-vaccine camp as you are when it comes to humans, but I feel differently when it comes to my cats. It's not that I think that animal vaccines are bad, in fact all of my cats have been vaccinated. What I question is the wisdom of ANNUAL vaccinations, especially for indoor only cats who aren't exposed to other animals. There's no evidence that vaccinating every year is at all beneficial, and there are plenty of examples of injection site carcinomas, plus my cats always get feverish and sluggish for a week after getting shots.

But reading this makes me wonder if there isn't some inconsistancy in my viewpoint. Hmmm...

I also think the Peak Oil Hausfrau has an excellent point about the childhood mortality rate. I think people tend to count their own experiences much more than they count statistics though.

Some vaccines may be acceptable, at some times. Unless you are live in/going to the tropics no need for tropical disease vaccines; mumps vaccine shortly before puberty; tetanus if you come into contact with soil and/or animals etc.

I think that this issue (and so many others - education, diet, health care) suffers from a unified "one answer for everyone, always approach".

I certainly won't be making a general announcement to my anti-vac friends, but I'm not going to lie either. I'm sure the issue will come up -- because it comes up all the time already -- and when it does, I'm going to tell them the truth. I sincerely hope that we'll be mature enough to agree to disagree.

EcoCatLady said... "I think people tend to count their own experiences much more than they count statistics though."

In my experience, this is SO true and SO annoying. It's one thing to deal with someone who draws a different conclusion from the same research. It's a whole other to deal with someone who refuses to listen to evidence because they have "personal experience" with the issue.

...and on a completely different level, you have a few religions that don't vaccinate. I'm 25 now and was raised in one of those religions. I'll get vaccinations if they're suggested for international travel, but since I'm no longer particularly prone to the childhood diseases, I'm certainly not going to backtrack and catch up on those. Also, needles freak me out (could be a byproduct of not being raised around them).

Anyway, I guess my point here is this: because everyone I grew up with was vaccinated, I really wasn't at risk for much of anything. Were the split closer to 50/50, it'd be interesting to study. But I do wonder about the vaccine cocktails at young ages; as an adult, vaccine cocktails can wipe you out for days on end, how can it be any better for the kids?

Spouse and I have at least avoided further disagreement on this; our dog gets vaccinated and we'll be having no children.

To add my two cents to the vaccination issue - most people I know of that have chosen not to vaccinate are not trying to convince the rest of us not to vaccinate. In fact, they're banking on the fact that most people will continue to vaccinate their kids so they can choose not to with little fear that their kids will end up with the measles, polio, and the like. So the argument that Peak Oil Hausfrau brings up wouldn't persuade those anti-vaccinaters - it's not that they want to go back to pre-vaccination days, they just want the best of both worlds. Also, when it comes to your own kids, it's pretty hard to say, "I'll take one for the team."

And though all three of my kids have gotten it, I still think the chicken pox vaccine is stupid.

EcoCatLady, I know nothing about cat vaccinations, but if what you say is true and there is no evidence in favor of annual vaccinations, then I'm not sure your position is inconsistent. Sounds like you are pro-vaccines when there are good medical reasons for them.

Anon, I think you're right to some extent. I certainly don't think that everyone has to get vaccinated for EVERYTHING. That said, I think there is a standard set of vaccinations that children get pretty immediately and I think that most of those are fairly legit.

Hippie, I commend you. I think you're right not to lie, but I'm sure it might be tempting to do so.

Heidi, I think the point you made is what makes this so difficult for those who are in the "pro-vaccination" camp. To a certain extent, those that do not vaccinate are free riding on those that vaccinate. Because everyone around you vaccinated, you didn't get any of those diseases. But if everyone didn't vaccinate, we'd be back to the huge childhood mortality rates we had in 1900. That feels unfair to a lot of people. See Erin's comment below.

Erin, I agree, I think the chicken pox vaccine seems unnecessary. On the other hand, now that so few kids are getting chicken pox, you can't count on your kid getting it as a child and it is MUCH worse as an adult, so I guess better to vaccinate?

Nice post! I'll keep it bookmarked for times when I get all Judgey McJudgeypants too :)

It is hard, though, to hear of kids dying or becoming disabled from preventable diseases, and to hear of cases like a kid I know who's currently in remission from leukemia who CAN'T be vaccinated because of all the treatments she's had, but who now may have to leave school after spending months fighting to get well enough to start going again, because the percentage of unvaccinated kids is going up so sharply that they can no longer rely on herd immunity protecting her. It upsets me because she's a really bright kid who loves school but who, unfortunately, is highly likely to relapse in the coming months / years, and she may not be able to spend the intervening time with her friends.

(rant over!)

Oh, and there's a lot of work now showing pretty strong evidence for a genetic basis to autism. The gold standard is to compare the rates of autism in pairs of identical vs. non-identical twins - all twins share the same womb and the same environment after birth, but only identical twins share the same genes, so you can really tease out the influence of the genes. If one of a pair of identical twins is autistic, there's a MUCH higher chance that their twin also has it, compared to the rates of non-identical twins both being autistic.

Which isn't to say that the genetic basis just makes you more likely to respond to an environmental trigger - no-one knows for sure what causes autism.

Part of the problem is that the medical community/government has taken the "all vaccines, to everyone, at the same age" stance. Convenient, cheaper, simpler, expedient - yes, but is this the best way? What happened to communication?

But what about flexibility and assuming parents can make informed choices? Maybe all children don't need all vaccines. Maybe multi-vaccines aren't such a good idea. Maybe initiating vaccinations almost at birth isn't necessary. Everyone may not need to be on the exact same schedule.

I come down on the "Its unfair to ask others to take risks that you are unwilling to take yourself" side of the fence. But I've never had a child and so it might be different if I was asked to make decisions for them.

Rosa said

"So maybe judging is the answer. I know for me, I get a *lot* of judgement about my choices from people who are just basing it on "well that's just not normal" "

Shes assuming that judging is good when used properly but shes also saying in the same breath that people don't think, they just react. Which is completely against the idea of using it effectively to help the group be safe. It can be miss-used very easily if 'norms' are not good for the group and people have knee-jerk reactions to people outside the norms.

Another related issue is:

People look at the research on vaccination and make a decision based on whats good for their kids, not whats best for everyone. However they rely on the group to protect them by being vaccinated.

How can the group protect them if they aren't willing to participate in their own protection?